Addressing threats to health care's core values, especially those stemming from concentration and abuse of power. Advocating for accountability, integrity, transparency, honesty and ethics in leadership and governance of health care.

Tuesday, November 27, 2007

A (Well Deserved) Rant about the RUC

On DB's Medical Rants, the nominally anonymous blogger took on the RUC (RBRVS Update Committee).

I am starting to believe that the distortions of physician reimbursement orchestrated behind the scenes by the shadowy RUC are one of the main reasons US health care is in such a mess. We had posted about the RUC, based on some important articles published this year that first brought its machinations to light (1,2,3) here and here.

A new article just appeared in JAMA on the topic(4) by the perspicacious Dr John Goodson, which provided a focus for what was really a Medical Rant:

The story of the RUC often reminds me of conspiracy theories. They (we never really know who they are) determine the fate of the world (or at least the economy). The RUC has disproportionate power and has apparently taken a reasonable idea (RBRVS) and corrupted it. If you want to know who to really blame, it is the RUC. I blame the AMA for developing a committee which does not represent the interest of overall health care, but rather the interests of subspecialties.

I do believe that the RUC has done more to negatively impact outpatient continuity, chronic care than any single entity.

This issue deserves more attention. We must expose this problem and make it reach the national conscious. I fear that it is important but a bit obtuse. I cannot imagine a sound bite approach to the evil the RUC has wrought.

4 comments:

Anonymous
said...

I feel it is important to remember the political clout the AMA wields while representing a minority of doctors. An area close to me is during the Clinton administration, the FAA along with the various pilot groups, proposed dropping the third class medical required for private pilots flying for personal reasons. There was never a safety issue, nor has there been a safety issue proven since, but the AMA stopped this proposal due to "economic loss" of income to doctors.

The cost added to the aviation system has been incalculable. Recently one pilot group reminded pilots to choose a doctor with an aviation background. Reading between the lines, doctors were using this medical requirement to generate additional test.

A case in point is a friend who upon reaching 50 was required, as a part of his physical, to submit to a prostate exam. Three biopsies later they could still not find a problem. The insurance company will not pay for any more biopsies until a change is found. My friend now must produce proof of ongoing testing to retain his pilot's license.

My point is, the AMA used it's political clout, not to resolve a medical issue, but to simply generate additional income for doctors as a group. Doctors have in turn used this to generate additional income through the ordering of test, and specialty referrals, with no enhancement of aviation safety.

From my perspective the AMA's function appears to be to generate additional income for the medical field. This translates into additional cost to society, and additional out of pocket cost for the individual. How far will the AMA go? Doctors need to remember that the AMA sells information it gathers on members, and nonmember doctors, to pharma, device makers and others for a profit.

Information regarding medical issues and pilot safety can be found by contacting AOPA at www.aopa.org. I am a member of this organization but hold no position on any governing body.

Steve Lucas you dont know what you are talking about. The AMA is powerful only within the medical community, not within society at large.

AMA fought against Medicare and was resoundly defeated. AMA fought against Medicaid and was resoundly defeated. AMA fought against CHIP and once again, lost. They havent had any real power for 40 years.

If the AMA was so powerful, then doctors incomes across the board should be skyrocketing every year, but thats not happening.

The CMS tells the RUC how much money its going to spend on doctors that year, thru the SGR formula. Then the RUC takes that money and decides how to split it up amongst doctors. RUC has more specialists than primary care docs, so of cousre the primary care docs get shafted.

The RUC is a power structure relevant only to other doctors. Their power outside of the medical community is virtually non-existent.

Basically the SGR decides in advance how much its going to pay doctors and leaves it up to the RUC to decide how the pie is split up. The RUC does NOT decide how much to pay all doctors in general.

"the FAA along with the various pilot groups, proposed dropping the third class medical required for private pilots flying for personal reasons. There was never a safety issue, nor has there been a safety issue proven since, but the AMA stopped this proposal due to "economic loss" of income to doctors.

The cost added to the aviation system has been incalculable. Recently one pilot group reminded pilots to choose a doctor with an aviation background. Reading between the lines, doctors were using this medical requirement to generate additional test"

thats crap. Third class medicals cost anywhere from $35 to $75 or so. For you to think its a major cash cow for docs or a major burden in overall flight costs is just ridiculous

Also I want a link that proves that the AMA killed the proposal to do away with pilot medical exams. Thats a load of crap too.

First, my reference was to the AMA's lobbying efforts regarding the third class physical, not specifically doctor reimbursement.

Secondly, AOPA as listed, can provide safety information regarding private pilots and medical disabilities. The information regarding the third class medical debate would be old by now and I do not have it at hand. We are talking over eight years ago. You will note the development of the Light Sport license that uses a drivers license as proof of medical ability as an effort to mitigate this situation.

A third class medical in my rust belt community cost $90 plus any additional testing required, plus any extra office visits. Remember we are talking about the economic impact on hundreds of thousands of private pilots. The total cost of a physical is not what is paid the doctor, but the time spend coming and going to the appointment, plus the possibility of additional testing and those related cost.

I view the AMA as a lobbying organization. The point in DB's rant concerns the AMA taking on the role of government agency with no public oversight. Certain doctor fees have skyrocketed due to their representation on the RUC. The AMA recently opened its membership to all those interested in the medical field. This would include drug companies, device makers, and their reps. Thus the shift to procedural payments should not be a surprise.

The AMA is still very effective at lobbying and will tie its interest to those of pharma and others in the medical field. Remember it does not matter what you or I think of the AMA, their audience is the public and politicians. They have done a very good job of convincing them they, the AMA, speaks for doctors.

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